Reducing same day cancellations due to patient related factors in elective orthopaedic surgery: experience of a centre in the UK.

Cancellations on the day of surgery represent a major wastage of resources and can impose significant distress on patients. Minimising same day cancellations can improve cost effectiveness of operating theatre running. The aim of the study was to determine the impact of administering a questionnaire, by phone to elective orthopaedic patients, the week prior to surgery. This questionnaire was aimed at identifying factors that could lead to same day cancellation for patient related reasons. The questionnaire was administered to elective orthopaedic patients over a nine month period. The rate of same day cancellations due to patient related reasons in this cohort (Phase 2) was compared with a previous cohort assessed over a five month period when the questionnaire was not in place (Phase 1). Administering the questionnaire reduced the same day cancellations due to patient reasons from 11 out of 110 (10%) to 2 out of 118 (1.60%) (p = 0.01). Theatre wastage in terms of national tariff lost due to cancellations was reduced from 25,881 sterling pounds to 1,650 sterling pounds (p<0.001). The study concludes that administering a questionnaire aimed at addressing patient related reasons can significantly reduce same day cancellations.

High-order nodal discontinuous Galerkin methods for the Maxwell eigenvalue problem.

The Maxwell eigenvalue problem is known to pose difficulties for standard numerical methods, predominantly due to its large null space. As an alternative to the widespread use of Galerkin finite-element methods based on curl-conforming elements, we propose to use high-order nodal elements in a discontinuous element scheme. We consider both two- and three-dimensional problems and show the former to be without problems in a wide range of cases. Numerical experiments suggest the validity of this for general problems. For the three-dimensional eigenproblem, we encounter difficulties with a naive formulation of the scheme and propose minor modifications, intimately related to the discontinuous nature of the formulation, to overcome these concerns. We conclude by connecting the findings to time domain solution of Maxwell's equations. The discussion, analysis, and numerous computational experiments suggest that using discontinuous element schemes for solving Maxwell's equation in the frequency- or time-domain present a high-order accurate, efficient and robust alternative to classical Galerkin finite-element methods.

Evaluation of a local optometric diabetic retinopathy screening service.

AIMS: To determine the sensitivity and specificity for sight-threatening eye disease (STED) of the diabetic retinopathy screening scheme for Stockport during the period 1 April 2000 to 31 March 2001. METHODS: A random sample of screen-negative patients was recalled for further assessment by consultant ophthalmologists. Screen-positive patients, who were referred, were tracked through the hospital system to determine the outcome. RESULTS: In a 12-month period, 3510 individuals with diabetes were screened, which is 1.2% of the district population. Sensitivity for STED was 75.8%[95% confidence interval (CI) 49.3, 99.99] and specificity for STED was 99.0% (95% CI 98.6, 99.3). CONCLUSIONS: The current screening arrangements in Stockport are satisfactory in terms of sensitivity and specificity. Population coverage was 1.2% over 12 months and 1.5% over 15 months and needs to be improved. An integrated computerized register requires further development.